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7
Based on the best available evidence, the
Choosing Wisely antibiotics recommendations
are:
Infectious diseases
•
Do not use antibiotics in asymptomatic
bacteriuria. Antibiotic treatment of
patients with asymptomatic bacteriuria
is generally not indicated as it does not
decrease the incidence of symptomatic
urinary tract infection. This also includes
patients with indwelling urinary catheters.
Exceptions to this are pregnant women and
those undergoing a urological procedure.
•
Don’t take a swab or use antibiotics for
the management of a leg ulcer without
clinical infection. Lower leg ulcers, most
commonly venous ulcers, are often treated
with oral antibiotics, even in the absence
of evidence of clinical infection. There is
no evidence to support this use, except if
screening for carriage of multi-resistant
organisms. Also, a swab for microscopy
and culture, in the absence of signs of
infection is not recommended. Unnec-
essary antibiotics and swabbing will add to
healthcare costs, antimicrobial resistance
and patient allergy.
•
Avoid prescribing antibiotics for upper
respiratory tract infection. Most uncom-
plicated upper respiratory infections are
viral in aetiology and antibiotic therapy
is not indicated. Oral antibiotic therapy of
presumed URTI in febrile young infants
is not only ‘low value’ but can be actively
dangerous, in delaying presentation to
hospital (inappropriately reassuring
parents and confounding investiga-
tions of sepsis). This is a major issue for
paediatrics primary care and ED presen-
tations. Patient education is an important
component of management together with
symptomatic treatment. Infections with
Streptococcus pyogenes and Bordetella
pertussis do require antibiotic therapy.
Intensive care medicine
•
Consider antibiotic de-escalation daily.
Infection can precipitate a need for
intensive care admission and can occur
as a complication of an ICU admission.
Antibiotics are frequently used for the
presumptive management of patients with
‘sepsis’ that may later prove to not have
an infectious aetiology. In most circum-
stances, data regarding the appropriate
duration of antibiotic administration
are very difficult to interpret. In some
conditions, such as endocarditis or osteo-
myelitis, longer courses of antibiotics have
been recommended. However, increasing
evidence shows that shorter courses of
antibiotics for common infections such
as hospital-acquired pneumonia do not
confer worse outcomes or increased
mortality than longer courses, and
probably help to prevent the development
of antibiotic resistance.
FEATURE